request for information for project # 14-09-05 project ......september 13, 2014 rfi advertised in...

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REQUEST FOR INFORMATION

For

Project # 14-09-05

Project Name: RFI / High School Math Screener

The Houston Independent School District (“HISD” and/or the “District”) is issuing a Public Request for Information (RFI) from qualified firms with the ability to provide HISD with a survey instrument(s) that provide school leaders and teachers with feedback on instruction students receive, the management teachers experience, and the instructional culture teachers and students experience in HISD. The project is more fully described in Section III of this Request for Information (“RFI”). One (1) signed original and one (1) copy of the original on PDF format on a CD or USB Flash drive must be submitted in accordance with the instructions set out herein to: Houston Independent School District Board Services - Room 1C03 Attn: Everlynn Goff RFI /High School Math Screener/ Project 14-09-05

4400 West 18th Street Houston, TX 77092

The original response must be submitted in a binder. The original must be labeled “ORIGINAL” and contain original signatures. The binder and any container for the binder(s) must be labeled on the outside with the Respondent’s name, address, the RFI number and the RFI name. RFI responses will be received at the above address until 3:00 PM on September 24, 2014. Central Daylight Savings Time. Written questions should be directed to Board Services at [email protected] prior to written question deadline of 5:00 PM September 19, 2014 Central Daylight Savings Time. Responses will be prepared for questions submitted and posted on the District’s website. A more detailed timeline is set out in the Instructions, Submission Requirements and Procedures section of the RFI. RFI responses will be reviewed as received in a manner that avoids disclosure to other Respondents. Contents of RFI responses will remain confidential during the Code of Silence period (as defined in Section 1.1.2 of the RFI). Only the RFI number and the identity of the Respondent(s) submitting the RFI response will be made available to the public before any award of a contract(s). RFI responses received after the due date and time will not be considered. Faxed or emailed responses will not be accepted. Responses must be submitted in sufficient time to be received and time-stamped at the above location on or before the RFI due date and time. HISD will not be responsible for responses delivered late by the United States Postal Service, or any other delivery or courier services.

mailto:[email protected]

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More details regarding the specifications are included in Section III, which is the Scope of Work and Specific Conditions section of this RFI.

Gilberto Carles ______________________________________ January 17, 2014 Gilberto Carles General Manager – Procurement Services Date

Project Name: RFI/High School Math Screener - Project # 14-09-05

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Table of Contents I. INSTRUCTIONS, SUBMISSION REQUIREMENTS AND PROCEDURES ........................... 5

1.1 GENERAL INFORMATION: ................................................................................................. 5

1.1.1 CODE OF SILENCE AND CONFLICTS OF INTEREST: .................................................. 5

1.1.2 DEFINITIONS AND TERMS: ........................................................................................... 6

1.3 SPECIFICATIONS: .............................................................................................................. 6

1.4 RFI INFORMATION REQUIRED: ....................................................................................... 6

1.5 MODIFICATION OR WITHDRAWAL OF RFI response: ...................................................... 6

1.6 OPENING RFI: ..................................................................................................................... 6

1.7 SCHEDULE:......................................................................................................................... 7

1.10 RETENTION OF RFI DOCUMENTATION: ........................................................................ 7

1.11 RESERVATION OF RIGHTS: ............................................................................................ 7

II. GENERAL TERMS AND CONDITIONS ................................................................................ 8

2.1 CONFIDENTIAL AND PROPRIETARY INFORMATION: ..................................................... 8

2.2 TEXAS PUBLIC INFORMATION ACT (TPIA): ..................................................................... 8

2.3 QUANTITY: ......................................................................................................................... 8

2.4 GOVERNING LAW: ............................................................................................................ 8

2.5 NO WAIVER OF IMMUNITY: ............................................................................................... 8

2.6 NOTICE: .............................................................................................................................. 9

2.7 SECTION HEADINGS: ........................................................................................................ 9

2.8 THIRD PARTY BENEFICIARIES: ........................................................................................ 9

2.9 UNENFORCEABLE SECTIONS: ......................................................................................... 9

2.10 ATTORNEY FEES: ............................................................................................................ 9

III. SCOPE OF WORK AND SPECIFIC CONDITIONS ............................................................ 10

3.1 SCOPE OF SERVICES: ................................................................................................... 10

3.3 SUBMITTAL CONTENT: ................................................................................................... 12

IV. FORM A - CERTIFICATION AND DISCLOSURE STATEMENT ...................................... 13

V. FORM B - MWBE Documents .......................................................................................... 29

VI. FORM C - CERTIFICATION REGARDING DEBARMENT AND SUSPENSION ............. 17

VII. FORM D - STATEMENT OF NON-COLLUSION ........................................................... 18

VIII. FORM E - ANTI-TRUST CERTIFICATION STATEMENT ............................................ 19

IX. FORM F - CONFLICT OF INTEREST QUESTIONNAIRE FORM .................................. 20

XI. FORM H - EXCEPTION FORM ...................................................................................... 23


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XII. FORM I - AWARDEE RELATIONS – CHE (LOCAL) QUESTIONNAIRE ....................... 24


I. INSTRUCTIONS, SUBMISSION REQUIREMENTS AND PROCEDURES

1.1 GENERAL INFORMATION: The following instructions by the District are intended to afford Respondent(s) an equal opportunity to participate in the RFI process and provide a predetermined set of criteria representing the District’s business and service requirements. 1.1.1 CODE OF SILENCE AND CONFLICTS OF INTEREST: The HISD Board has adopted a “Code of Silence” (Board Policy CAA (Local) and “Conflict of Interest Disclosures” (Board Policy BBFA (Local) to enforce its commitment to ethical contracting standards and improve accountability and public confidence. It is important to avoid both the appearance of conflicts and actual conflicts of interest.

1.1.2 “The Code of Silence" shall mean a prohibition on any communication regarding any RFI, RFP, bid,

or other competitive solicitation between:

1. Any person who seeks an award from the District or its affiliated entities (including, but not limited to, the HISD Foundation and the HISD Public Facility Corporation), including a potential vendor or vendor's representative, and

2. Board members, the Superintendent of Schools, senior staff members, principals, department

heads, directors, managers, or other District representatives who have influence in the evaluation or selection process or anyone other than the Project Manager listed in Section 1.1.4 of this RFI.

The “Code of Silence” time period shall begin with the issuance of an RFI and ends upon the execution of the Agreement resulting from the issuance of a closed RFP that will be issued as a result of this RFI. During the “Code of Silence”, campaign contributions, gifts, donations, loans, and any other items of value are prohibited between these parties, including candidates who have filed for election to the Board. The “Conflict of Interest Disclosures” requires a Board member to disclose and recuse himself or herself from voting on any contract, agreement, or any other District transaction involving an entity or related officer and/or key employee who has provided campaign contributions during the preceding 12-month period in excess of $500. For more information please click on the following link:

http://www.houstonisd.org/Page/38486

Board Policy CAA (Local) pertaining to the “Code of Silence” and Board Policy BBFA (Local) pertaining to “Conflict of Interest Disclosures” are attached by URL link above and incorporated by reference. Please review the policies carefully and ensure that the policies are followed in all respects. Respondent(s) agree and understand that noncompliance with the “Code of Silence” policy may result in disqualification from this RFI and the RFP that will be published in conjunction with this project. Furthermore, the failure of a Board member to disclose a conflict of interest may result in the debarment of a vendor for 24 months. 1.1.3 By submitting a response, Respondent(s) agree to provide the information requested in full accordance with the scope of work and other documents as listed herein.

1.1.4 The designated project manager during the RFI process shall be Everlynn Goff, Procurement

Services, 4400 West 18th Street, Houston, Texas 77092 713-556-6536, (e-mail) [email protected]. 1.1.5 Questions concerning the RFI will be answered only if sent to the Procurement Services Department,

in writing via email to project manager on or before 5:00 PM on September 19, 2014. Central Daylight Savings Time.

http://www.houstonisd.org/Page/38486


1.1.6 All costs related to the preparation and submission of a response to this RFI shall be the responsibility

of the Respondent. Issuance of this RFI does not commit HISD, in any way, to pay any costs in the preparation and submission of the response. Nor does the issuance of the RFI obligate HISD to make an award, enter into an agreement, or purchase any goods and services stated in the RFI.

1.2 DEFINITIONS AND TERMS: In this RFI, terms are used as follows:

1.2.1 “Agreement” is defined in Section II, General Terms and Conditions. 1.2.2 “HISD”, “Owner”, and/or “District” refers to Houston Independent School District.

1.2.3 “Respondent” refers to the person/firm that submits a response to this RFI. 1.2.4 “Project” means the Scope of Work for furnishing services. 1.2.5 “Statement of Qualification”, refers to the document submitted in response to this RFI.

1.2.6 “RFI” refers to this Request for Information.

1.2.7 “Scope of Work” is set forth in Section III, Scope of Work and Specific Conditions.

1.2.8 “Awardee” refers to the person(s)/firm(s)/entity(ies) selected for an award of an Agreement pursuant to the RFP to be published as a result of this RFI (but subject to final execution of the Agreement by both the District and the Awardee). 1.2.9 Singular terms shall include the plural and vice versa. A gender reference includes both genders.

1.3 SPECIFICATIONS: Respondent(s) are expected to examine and be familiar with all requirements and obligations of this entire RFI. Failure to do so will be at the Respondent’s risk. All exceptions to the specifications and requirements of the RFI must be noted in detail in the Exception Form (Form H hereto) and included in the response to the RFI.

1.4 RFI INFORMATION REQUIRED: (PLEASE REFER TO THE SCOPE OF WORK, SECTION III.)

1.5 MODIFICATION OR WITHDRAWAL OF RFI RESPONSE: A Respondent may modify or withdraw its response by written or electronic notice received by the Project Manager prior to the exact hour and date specified as the deadline for receipt of the RFI response. A RFI response may also be withdrawn in person by a Respondent’s authorized representative prior to the RFI’s due date and time, provided the Respondent’s identity is confirmed and Respondent’s representative signs a receipt for the RFI response.

1.6 OPENING RFI: All RFI response may be opened as soon as received. A formal public "opening" will not be held. Trade secrets and confidential information contained in the RFI response shall not generally be open for public inspection, but HISD’s records are subject to the State of Texas Public Information Act requirements (also see Section 2.7 of this RFI).


1.7 SCHEDULE: The following schedule and timelines apply to this RFI. RFI key dates are the following:

September 13, 2014 RFI Advertised in Houston Chronicle

September 12, 2014 RFI Posted on the Procurement Web-Page

September 19, 2014 Deadline for receiving supplier questions

September 2014 RFI Responses Opened and Recorded

1.8 At the District’s sole discretion, one or more Respondent(s) may be invited to an interview/oral presentation. Said Respondent(s) will be notified by e-mail if the District determines that such interviews/oral presentations are needed. Respondent(s) shall demonstrate their competence, qualifications and/or ability to satisfy the District’s RFI requirements.

1.9 Timelines set forth herein may be strictly enforced by the District. The District, however, maintains sole discretion to adjust any deadline or timeline to suit the best interests of the District so long as it does not unduly and materially prejudice any Respondent.

1.9.1 Late arrival responses: Responses submitted after the due date and time noted in this RFI shall not be considered and shall be returned to the Respondent(s), unopened, by United States Mail. The District is not responsible for lateness of U.S. Mail, Commercial (Professional) Carrier, personal delivery, or any other delivery method. The time and date stamp clock in the Houston ISD’s Board Services Department, Room 1C03, Hattie Mae White Educational Support Center, 4400 West 18th Street, Houston, Texas 77092, shall be the official date and time of receipt. It shall be the sole responsibility of the Respondent(s) to ensure that his or her response is received at the appropriate location by the specified deadline. There shall be no exceptions to these requirements. 1.10 RETENTION OF RFI DOCUMENTATION: All response materials and supporting documentation that are submitted in response to this RFI become the permanent property of HISD. 1.11 RESERVATION OF RIGHTS: The District reserves the right to reject any RFI responses or any part of a RFI response. Additionally, the District reserves the right to waive any requirements of the RFI. The District further reserves the right to reject all RFI responses and seek new RFI responses when such actions would be deemed in the best interests of the District. The District reserves the right to waive any and all minor irregularities in the RFI responses. BY SUBMITTING A RESPONSE, THE RESPONDENT AGREES TO AND DOES HEREBY WAIVE ANY AND ALL CLAIMS IT HAS OR MAY HAVE AGAINST THE HOUSTON INDEPENDENT SCHOOL DISTRICT, AND ITS TRUSTEES, EMPLOYEES, OR AGENTS ARISING OUT OF OR IN CONNECTION WITH (1) THE ADMINISTRATION, EVALUATION, OR RECOMMENDATION OF ANY RESPONSE OR OFFER; (2) ANY REQUIREMENTS UNDER THE SOLICITATION, RFI,FOLLOWING RFP OR RELATED DOCUMENTS; (3) THE REJECTION OF ANY RESPONSE OR ANY PART OF ANY RESPONSE OR OFFER; (4) WAIVER BY THE HOUSTON INDEPENDENT SCHOOL DISTRICT OF ANY TECHNICALITIES IN THE RFI PACKAGE OR ANY RESPONSE, PROPOSAL, OR OFFER; (5) WAIVER OR CHANGE IN ANY NON-MATERIAL PROVISION OF THE RFI SOLICITATION PACKAGE OR MATERIALS THAT DO NOT ADVERSELY AND SPECIFICALLY AFFECT THE PREVIOUSLY SUBMITTED RESPONSES OR OFFERS; AND/OR (6) THE AWARD OF A CONTRACT, IF ANY.


II. GENERAL TERMS AND CONDITIONS

2.1 CONFIDENTIAL AND PROPRIETARY INFORMATION: The District and a Respondent and the Awardee(s), if any, may provide technical information, documentation and expertise to each other that is either (1) marked as being confidential or, (2) if delivered in oral form is summarized in writing within 10 working days and identified as being confidential (“Confidential Information”). Except as may otherwise be required by law, the receiving party shall for a period of five (5) years from the date of disclosure (i) hold the disclosing party’s Confidential Information in strict confidence, and (ii), except as previously authorized in writing by the disclosing party, not publish or disclose the disclosing party’s Confidential Information to anyone other than the receiving party’s employees or agents on a need-to-know basis, and (iii) use the disclosing party’s Confidential Information solely for performance of this Project. The foregoing requirement shall not apply to any portion of a party’s Confidential Information which (a) becomes publicly known through no wrongful act or omission on the part of the receiving party; (b) is already known to the receiving party at the time of the disclosure without similar nondisclosure obligations; (c) is rightfully received by the receiving party from a third party without similar nondisclosure obligations; (d) is approved for release by written authorization of the disclosing party; (e) is clearly demonstrated by the receiving party to have been independently developed by the receiving party without access to the disclosing party’s Confidential Information; or (f) is required to be disclosed by order of a court or governmental body or by applicable law, provided that the party intending to make such required disclosure shall notify the other party of such intended disclosure in order to allow such party to seek a protective order or other remedy. 2.2 TEXAS PUBLIC INFORMATION ACT (TPIA): Notwithstanding the requirements of Section 2.7 of this RFI, Respondents acknowledge that the District is subject to the Texas Public Information Act (TPIA). As such, upon receipt of a request under the TPIA, the District is required to comply with the requirements of the TPIA and nothing contained in this RFI; the resulting Agreement(s), if any; or any other document shall operate to require HISD to not fully comply with the TPIA. In the event that a request for documents involves documentation that a Respondent or an Awardee has clearly marked as confidential and/or proprietary, or otherwise is considered Confidential Information, the District will provide the person with the notices under the TPIA. Respondents and Awardees acknowledge that they have the responsibility to file exceptions with the Texas Attorney General's Office on why the documents identified as confidential and/or proprietary fall within an exception to public disclosure. 2.3 QUANTITY:

2.3.1 There is no guaranteed amount of business, expressed or implied, to be purchased, or contracted for by HISD.

2.3.2 The District expressly reserves the right to procure any services from other sources or by other means.

2.4 GOVERNING LAW: Any Agreement resulting from this RFI shall be governed by, construed and enforced in accordance with the laws of the State of Texas without regard to the conflicts or choice of law principles thereof. The parties irrevocably consent to the jurisdiction of the State of Texas, and agree that any court of competent jurisdiction located in the County of Harris, State of Texas, shall be an appropriate and convenient place of venue, and shall be the sole and exclusive place of venue, to resolve any dispute with respect to the Agreement.

2.5 NO WAIVER OF IMMUNITY: The District does not waive or relinquish any immunity or defense on behalf of itself and its trustees, officers, employees, and agents as a result of entering into any agreement or contract relating to any Project or by performing any of the functions or obligations relating to any Project. Nothing in any agreement shall be construed as creating any personal liability on the part of any trustee, officer, employee, or representative of HISD. No waiver of a breach of any provision of the contract and/or Agreement shall be construed to be a waiver of any breach of any other provision. No delay in acting with regard to any breach of any provision shall be construed to be a waiver of such breach.


2.6 NOTICE: Any notice required to be given relating to this RFI shall be in writing and shall be duly served when hand-delivered to the addressees set forth below, or shall have been deposited, duly registered or certified, return receipt requested, via the United States Postal Service, or if a party consents, via facsimile or electronic mail in accordance with the Texas Electronic Transactions Act; addressed to the other party at the following addresses:

To: Houston Independent School District Attn: Everlynn S. Goff 4400 West 18th Street Houston, Texas 77092 Facsimile: 713-556-6600 E-mail: [email protected] To: Houston Independent School District Attn: Kenneth Huewitt, CFO 4400 West 18th Street Houston, Texas 77092 Facsimile: 713-556-6600 E-mail: [email protected]

Copy To: Mr. Gilberto Carles General Manager – Procurement Services 4400 West 18th Street Houston, Texas 77092 Facsimile: 713-556-6564 E-mail: [email protected] Any party may designate a different address by giving the other party ten (10) days prior written notice in the manner provided above. 2.7 SECTION HEADINGS: The headings of sections and paragraphs contained in any document related to the RFI and any Agreement are for convenience only, and they shall not, expressly or by implication, limit, define, extend, or construe the terms or provisions relating to the project. 2.8 THIRD PARTY BENEFICIARIES: Nothing relating to any Project or resulting Agreement, if any, shall be deemed or construed to create any rights in any third party or otherwise give any third party any claim or right of action against HISD or the Awardee(s) including any rights in the nature of third party beneficiaries or fiduciaries. 2.9 UNENFORCEABLE SECTIONS: If any portion of this RFI or any Agreement is deemed to be unenforceable, the remainder of the RFI and Agreement shall be construed as if such unenforceable provisions had never been contained therein. 2.10 ATTORNEY FEES: In connection with HISD’s defense of any suit against it and/or HISD’s prosecution of any claim, counterclaim or action to enforce any of its rights and/or claims related to this RFI or any resulting Agreement, in which HISD prevails as to all or any portion of its defense(s), claims, counterclaims or actions, HISD shall be entitled to recover its actual attorney’s fee and expenses incurred in defending such suit and/or in prosecuting such claim or action.





III. SCOPE OF WORK AND SPECIFIC CONDITIONS

3.1 SCOPE OF SERVICES:

Mathematics SUMMARY The Houston Independent School District (HISD) is looking for an online universal screener for mathematics for high school students. The universal screener should report students’ mathematics level and be able to report students’ growth over time. Requirements Please describe or illustrate in detail how your product can satisfy the following requirements.

Description of Required Item Do you have? Yes or No

Page Reference in Your Submittal

Provides a variety of easily accessible, online reports for teachers and administrators

Student math achievement level with a description of how achievement level is measured

Student growth over time

Provides reports that can be exported into Excel, easily printed, or saved via PDF

Archives data over time so that teachers/schools can access student data from previous years, while integrating these data with the HISD data warehouse

Includes online, on-demand training for teachers and administrators

Describe provisions for technical support.

Describe provisions for user support.

ADA compliant; follows universal design for learning framework

System is capable of scheduling automated secure data imports via Clever.com at least daily at no additional cost

System is capable of scheduling automated secure data exports at least daily at no additional cost

Explain supported methods for system integration. Provide estimated cost, if any.

Conforms with current IMS (Instructional Management System) global standards and is able to integrate seamlessly with its learning management platform (preferred)

Supports single sign-on via SAML 2.0

Explain supported browsers including a list of appropriate


versions, i.e. Explorer 8.

Provide a list of compatible mobile devices such as iPads and Android tablets.

Per pupil cost for budgetary pricing

Is system externally hosted?

If externally hosted, will HISD’s data be inaccessible by your other customers and vice versa?

Is system FERPA-, CIPA-, and COPPA-compliant?

Preferred Features Please describe or illustrate in detail how your product can satisfy the following preferred features.

Description of Preferred Features Do you have? Yes or No

Page Reference in Your Submittal

Provides a variety of easily accessible, immediate, online reports for teachers and administrators

Specific, actionable diagnostic information by high school course, including readiness for entry-level college courses, that teachers can use to plan targeted lessons for above-, on-, and below-level students.

Tiers students according to the Response to Intervention three-tier model

Predicts success on standardized assessments

Includes correlations to Texas standards

Contract Term The District is seeking a cost-efficient proposal to provide services for an anticipated contract of one (1) year. The final description of services will be defined in a RFP, open only to vendors that respond to the RFI. The actual date of contract will be established by a completed and approved contract. 3.2.2 PROCEDURES FOR SUBMITTING PROPOSALS:

3.2.2.1 Delivery Methods: A. Mail Delivery:

Submit, in writing, one (1) original, two (2) hard copies of the original, and one (1) soft copy submitted in PDF format on CD media or USB Flash Drive to be received no later than 3:00 PM, September 24, 2014 Central Daylight Savings Time

TO: Project Number: 14-09-05 RFI – High School Math Screener

Deadline of 3:00 PM on September 24, 2014 Daylight Savings Time Houston Independent School District 4400 West 18th Street

Houston, Texas 77092


B. Hand Delivery: On hand-delivered proposals, it will be the sole responsibility of the submitting firms to have the proposal envelope date and time stamped in the Board of Education office before the deadline. RFI Responses will be neither date/time stamped nor accepted after the 3 PM CDST deadline. Envelopes should be plainly marked “RFI – High School Math Screener.”

3.2.2.2 Proposal Contents

A. Cover Letter

G. Required Forms Proposers shall complete forms A - I and include these forms with their submitted proposal. The submittal package must contain:

One (1) original submittal package with original signatures, and that set should be labeled “ORIGINAL” One (1) hard copies of the original. The set should be labeled “COPY” One (1) softcopy in PDF format submitted on CD media or USB Flash Drive.

3.3 SUBMITTAL CONTENT:

The printed original and printed copy of the RFI response shall be bound using metal spiral binding spines, plastic/vinyl comb binding spines, or other semi-permanent binding method, to ensure that pages are not lost. Pages shall be no larger than letter-size (8-1/2" by 11 ") or, if folded to that dimension, twice letter size (11" by 17"). Each section (defined below) shall be separated by a tabbed divider. Each RFI Response shall be organized in the following order:

1. Form A – CERTIFICATION AND DISCLOSURE STATEMENT

2. Form B – MWBE Form

3. Form C – FREE OF INDEBTEDNESS STATEMENT

4. Form D – CERTIFICATION REGARDING DEBARMENT AND SUSPENSION

5. Form E – STATEMENT OF NON-COLLUSION

6. Form F – ANTI-TRUST CERTIFICATION STATEMENT

7. Form G – CONFLICT OF INTEREST QUESTIONNAIRE

8. Form H – EXCEPTION FORM

9. Form I – AWARDEES’ RELATIONS – CHE (LOCAL) QUESTIONNAIRE

10. Proof of Insurance


IV. FORM A - CERTIFICATION AND DISCLOSURE STATEMENT

A person or business entity entering into a contract and/or agreement with HISD is required by Texas Law to disclose, in advance of the contract and/or agreement award, if the person or an owner or operator of the business entity has been convicted of a felony. The disclosure should include a general description of the conduct resulting in the conviction of a felony as provided in section 44.034 of the Texas Education Code. The requested information is being collected in accordance with applicable law. This requirement does not apply to a publicly held corporation.

If an individually owned Company:

Has the owner(s) ever been convicted of a felony? Yes No

If a Corporation, Partnership, Limited Partnership, etc:

Has any owner, or partner, of your business entity been convicted of a felony? Yes No

Has any manager or director of your entity been convicted of a felony? Yes No

Has any employee of your entity been convicted of a felony? Yes No

If Yes, give details:

_____________________________________________________________________________

_____________________________________________________________________________

If you answered yes to any of the above questions, please provide a general description of the conduct resulting in the conviction of the felony, including the Case Number, the applicable dates, the State and County where the conviction occurred, and the sentence. (Attach additional pages, if necessary.)

I attest that I have answered the questions concerning prior convictions truthfully and to the best of my knowledge.

_______________________________________________ CORPORATE OFFICER’S SIGNATURE ________________________________________________ PRINTED NAME ________________________________________________

TITLE


VI. FORM –B

M/WBE PARTICIPATION REPORT

The Office of Business Assistance was established by the Board of Education in 1988 to assist minority and women-owned businesses (“M/WBE”) to participate in various District business projects. The District’s M/WBE participation goals are as follows: NOTE: For the purpose of this RFI—complete the form with a percentage figure if you are using option B or C. This form is not a requirement of the RFI but will be required should you choose to participate in the follow-up RFP. If the form is completed during this RFI process it will not be a requirement for your company during the RFP process. 20% for Purchasing 20% for Construction 25% for Professional Services The District requires all M/WBE documents and supporting materials to be completed and submitted with a response to a Request for Proposal. The attached M/WBE form is the approved District form that must be used when submitting your proposal. If the Proposer(s) has an adoptive, operative M/WBE program, information concerning the program should be included and submitted with this Form. Please select the option that is applicable to your proposal and submit ONLY those documents pertaining to the option selected. The form should be submitted with a manual signature by an official from the Proposer’s company. Detailed below are descriptions of the three options:

Option A is to be used by entities that are certified by one of the following agencies: City of Houston (MBE and/or WBE only); Houston Minority Supplier Development Council and Women’s Business Enterprise Alliance. Option B is to be used by entities that are not certified, but will directly utilize M/WBE businesses to meet and/or exceed the District’s appropriate 20-25% participation goal. Option C is to be used by entities that are not certified and are unable to meet the District’s participation goal, but will meet the minimum standards of “Good Faith”. (Please see Option C on attached M/WBE form for more details on “Good Faith Efforts” documentation)

To better assist Proposers and/or Suppliers interested in working with the District and to address specific questions on the M/WBE documentation, the Business Assistance Department hosts a meeting the first Monday of each month beginning at 8:30 a.m. at the Hattie Mae White Educational Support Center. For questions regarding the District’s M/WBE program, how to complete the attached form, or information on monthly meetings, please contact Business Assistance at (713) 556-7273.


V. FORM C - FREE OF INDEBTEDNESS STATEMENT The Texas Education Code (Section 44.044) provides that school districts, by resolution of the Board of Trustees, may establish regulations requiring that persons or entities entering into a contract and/or agreement or transaction with the District not be indebted to the District. The Board of Education has approved a resolution establishing policy that requires that the awarded, or selected, Awardees be free of any indebtedness to the District. The following information must be completed by individual and/or business entities. List all the tax account numbers for all property taxes due the Houston Independent School District: ______________________________________ ___________________________________ ______________________________________ ___________________________________ ______________________________________ ___________________________________ ______________________________________ ___________________________________ Are all City, County, and Houston Independent School District property taxes, both real and personal, assessed against property owned by individual and/or business entity paid?

Yes No If you answer “no” to this question, provide detail of the amounts due the District and your current plan to satisfy this indebtedness. I attest that I have answered the questions regarding indebtedness to the Houston Independent School District truthfully and to the best of my knowledge.


TITLE


FORM D -

VI. FORM D - CERTIFICATION REGARDING DEBARMENT AND SUSPENSION

The undersigned certifies on behalf of the company and its key employees that neither the company nor its key employees have been proposed for debarment, debarred or suspended by any Federal Agency. The undersigned agrees to notify the District in the event that the company or any of its key employees are proposed for debarment, debarred or suspended by any Federal Agency or by any State of Texas agency. Notification shall take place within five (5) business days after the company or employee is notified of either debarment or suspension or possible debarment or suspension. Notification shall be sent to Mr. Christopher L. Gross, C.P.M; General Manager – Procurement Services; Houston Independent School District; 4400 West 18th Street; Houston, Texas 77092. I attest that I have answered the questions regarding debarment and suspension truthfully and to the best of my knowledge.


TITLE


FORM E -

VII. FORM E - STATEMENT OF NON-COLLUSION

The undersigned Respondent does hereby certify:

a) That all statements of fact in such RFI response are true. b) That such RFI response was not made in the interest of, or on behalf of any undisclosed person, partnership,

company, association, organization or corporation. c) That such RFI response is genuine and not collusive or sham. d) That Respondent(s) has not, directly or indirectly by agreement, communication or conference with anyone,

attempted to induce action prejudicial to the interest of the District or of any other bidder or anyone else interested in the proposed procurement.

e) That Respondent(s) did not, directly or indirectly, collude, conspire, connive or agree with anyone else who would submit a false or sham RFI response.

f) That Respondent(s) did not, directly or indirectly divulge information on data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any individual or group of individuals, except to the District, or to any person or persons who have a partnership or other financial interest with said Respondent in his business.

g) That Respondent(s) did not provide, directly or indirectly to any officer or employee of the District any gratuity, entertainment, meals, or anything of value, whatsoever, which could be construed as intending to invoke any form of reciprocation or favorable treatment.

h) That no officer or principal of the undersigned firm is related to any officer or employee of the District by blood or marriage within the third degree or is employed, either full or part time, by the District either currently or within the last two (2) years.

i) That no officer or principal of the undersigned firm nor any subcontractor to be engaged by the principal has been convicted by a court of competent jurisdiction of any charge of fraud, bribery, collusion, conspiracy or any other act in violation of any state or federal anti-trust law in connection with the bidding, award of, or performance of any public work contract and/or agreement with any public entity.

I attest that I have answered the questions regarding non-collusion truthfully and to the best of my knowledge.

CORPORATE OFFICER’S SIGNATURE PRINTED NAME

TITLE


FORM F -

VIII. FORM F - ANTI-TRUST CERTIFICATION STATEMENT (Texas Government Code §2155.005)

I affirm under penalty of perjury of the laws of the State of Texas that:

1. I am duly authorized to respond to this RFI on my own behalf or on behalf of the company, corporation, firm, partnership or individual (Company) listed below;

2. In connection with this RFI, neither I nor any representative of the Company have violated any

provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus & Comm. Code Chapter 15;

3. In connection with this RFI, neither I nor any representative of the Company have violated any federal antitrust law; and

4. Neither I nor any representative of the Company have directly or indirectly communicated any of

the contents of this RFI to a competitor of the Company or any other company, corporation, firm, partnership or individual engaged in the same line of business as the Company.

Company Name Company Address City, State, Zip Code Phone Facsimile Respondent Signature Respondent Printed Name Position with Company

(IF DIFFERENT FROM ABOVE) Official Authorizing RFI Response Corporate Officer’s Signature Printed Name Position with Company


FORM G -

IX. FORM G - CONFLICT OF INTEREST QUESTIONNAIRE FORM

CONFLICT OF INTEREST QUESTIONNAIRE FORM FORM CIQ For Vendor or other person doing business with local governmental entity

This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity. By law this questionnaire must be filed with the records administrator of the local government not later than the 7 th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor.

OFFICE USE ONLY Date Received

1. Name of person doing business with local governmental entity.

2. Check this box if you are filing an update to a previously filed questionnaire.

(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 st of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)

3. Describe each affiliation or business relationship with an employee or contractor of the local governmental en tity who makes recommendations to a local government officer of the local governmental entity with respect to expenditure of money.

4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local governmental entity that is the subject of this questionnaire.


FORM G -

CONFLICT OF INTEREST QUESTIONNAIRE FORM FORM CIQ For Vendor or other person doing business with local governmental entity Page 2

5. Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if

the answer to A, B, or C is YES.)

This section, item 5 including subparts A, B, C, & D, must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire?

Yes No

B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section AND the taxable income is not from the local governmental entity?

Yes No

C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

Yes No

D. Describe each affiliation or business relationship.

6. Describe any other affiliation or business relationship that might cause a conflict of interest.

COMPANY NAME

CORPORATE OFFICER’S SIGNATURE

PRINTED NAME

TITLE


FORM G -

Affiant certifies that he or she is duly authorized to submit the above information on behalf of the Respondent, that Affiant is associated with the RFI response in the capacity noted above and has personal knowledge of the accuracy of the information provided herein, and that the information provided herein is true and correct to the best of Affiant’s knowledge and belief. Affiant SWORN TO AND SUBSCRIBED before me this _____day of ______________, 20___. (seal) Notary Public


FORM H -

XI. FORM H - EXCEPTION FORM

All deviations and exceptions to this RFI must be expressly stated in this Exception Form (additional pages to this form may be added if necessary). In the absence of any entry on this Exception Form, the Respondent(s) assures HISD of their full agreement and compliance with all specifications, terms and conditions, requirements and obligations of the RFI. THIS EXCEPTION FORM MUST BE SIGNED BY EACH RESPONDENT(S) WHETHER THERE ARE EXCEPTIONS LISTED OR NOT, AND SUBMITTED WITH THE RFI RESPONSE.

SECTION #, PARAGRAPH # (OR SUBSECTION #) AND PAGE

EXCEPTION

Company Name Corporate Officer’s Signature Printed Name


FORM I -

XII. FORM I - AWARDEE RELATIONS – CHE (LOCAL) QUESTIONNAIRE

Board of Education Policy CHE (Local) adopted October 11, 2012 requested that all Respondents supply the Board of Education the information contained below. While this information is requested in other parts of Form A this questionnaire provides the information specifically related to CHE (Local).

Legal Name of Business:_________________________________________________________________ Type of Business and types of products or services provided: _____________________________________________________________________________________ ____________________________________________________________________________________. Business Mailing Address: ______________________________________________________________. City: __________________________ State: ______________________Zip Code___________________ Business Street Address: ________________________________________________________________ City: __________________________ State: ______________________Zip Code____________________ Names of parent company, subsidiaries, or other name under which they are currently conducting or have previously conducted business with the District:

Parent Company

Subsidiaries Subsidiaries

Other Names Other Names

Number of Full Time Employees: ____________________ Part Time Employees:____________________


FORM I -

Names of owners, principal shareholders or stockholders, officers, agents, salespeople and key employees who fall within the category of: present and former (within the past 5 years) Members of the Board:

Name Title

Names of District employees and members of their immediate families working or potentially working on the District’s contract:

Names Names

Ethnic group of the majority owners (to identify minority businesses) _______________________________ ______________________________________________________________________________________ Authorized agents, including any person or entity that is authorized to ‘act with’ or ‘act on your behalf’, such as consultants, sub-contractors, re-sellers, and/or lobbyist, confidants, etc., whether compensated or not compensated.


FORM I -

Names Names

Certification of authority and/or any license or certificate required to conduct business within the State of Texas and/or any applicable local municipalities in accordance with any governing federal, state, and local statutes, regulations and ordinances:

License Number and Type License Number and Type

Financial and business references, including bank with which the company conducts business: Name of Bank: __________________________________________________________________________ Bank Officer ______________________________ Officers Telephone Number_______________________ Other Banking/finance Institutions:


FORM I -

Finance Institution Name Finance Institution Name

Name of insurance companies and bonding company (if applicable)

Insurance Companies Insurance Companies

Bonding Company Bonding Company


FORM I -

Identification of any past, pending, or present litigation involving your firm and any company owners, principal shareholders or stockholders, officers, agents, salespeople or employees over the last ten years.

Style of Litigation Type of Litigation Current Status

Relationship to any Political Action Committees (PAC) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

(Make copies of any table if additional rows are needed and attach additional sheets) I attest that I have answered the questions relating to CHE (Local) truthfully and to be best of my knowledge.

________________________________________________________ CORPORATE OFFICER’S SIGNATURE

________________________________________________________ PRINTED NAME

________________________________________________________ TITLE